<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-6483</journal-id>
<journal-title><![CDATA[Endoscopia]]></journal-title>
<abbrev-journal-title><![CDATA[Endoscopia]]></abbrev-journal-title>
<issn>2444-6483</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Endoscopia Gastrointestinal A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-64832019000600245</article-id>
<article-id pub-id-type="doi">10.24875/end.m19000104</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Morfología de la papila de la Váter como factor de riesgo para canulación biliar difícil y complicaciones]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valdivia-Correa]]></surname>
<given-names><![CDATA[Bárbara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrera-Esquivel]]></surname>
<given-names><![CDATA[José de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Délano-Alonso]]></surname>
<given-names><![CDATA[Roberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valenzuela-Salazar]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bada-Yllán]]></surname>
<given-names><![CDATA[Orlando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Angulo]]></surname>
<given-names><![CDATA[Jaime A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreno-Portillo]]></surname>
<given-names><![CDATA[Mucio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General &#8220;Dr. Manuel Gea González&#8221; Servicio de Endoscopia Gastrointestinal ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<fpage>245</fpage>
<lpage>251</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-64832019000600245&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-64832019000600245&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-64832019000600245&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La canulación biliar difícil (CBD) ocurre en aproximadamente el 20% de las colangiopancreatografías retrógradas endoscópicas (CPRE) y se encuentra asociada al desarrollo de complicaciones, específicamente pancreatitis post-CPRE. La morfología de la papila de Vater podría estar asociada a CBD; sin embargo, existen pocas clasificaciones endoscópicas, las cuales no han sido validadas externamente ni correlacionadas con desenlaces clínicos.  Objetivo: Validar una clasificación endoscópica de la papila de Váter y analizar la asociación del tipo de papila con el riesgo de CBD y complicaciones.  Material y métodos: Estudio retrospectivo, prolectivo, analítico y transversal. Se incluyeron pacientes consecutivos mayores de 18 años sometidos a CPRE con papila nativa. Para validar la escala endoscópica propuesta por Harraldson y cols. se distribuyeron las imágenes endoscópicas entre 6 endoscopistas para calcular la variabilidad interobservador mediante el coeficiente kappa de Cohen. El estándar de oro se consideró el consenso de dos endoscopistas expertos; en caso de que existiera desacuerdo un tercer endoscopista dio pauta al resultado final. Se correlacionó el tipo de papila con la tasa de CBD y complicaciones (pancreatitis post-CPRE, sangrado post-esfinterotomía, perforación) usando un modelo de regresión logística.  Resultados: Se incluyeron 100 pacientes (edad promedio 47±19.1 años, 75% mujeres). La principal indicación fue riesgo alto de coledocolitiasis. Se obtuvo un índice de kappa de 0.634 (95% IC: 0.512-0.757) para los endoscopistas expertos, 0.565 (95% IC: 0.439-0.692) para los no expertos y 0.208 (95% IC: 0.048-0.367) para los residentes. Los pacientes fueron divididos según el tipo de papila (tipos 1 a 4). El porcentaje de CBD fue menor para la papila tipo 1, por lo que se eligió como comparador de riesgo. La papila tipo 2 (OR 4.4 (IC 95% 1.48-13.31, p=0.008) y la papila tipo 4 (OR 4.2 IC 95% 1.30 &#8211; 14.03, p=0.016) se asociaron a un mayor riesgo de CBD. La papila tipo 2 (OR 3.18 IC 95% 1.08 &#8211; 9.34, p=0.035) se asoció a un mayor riesgo de complicaciones.  Conclusión: Las papilas tipo 2 y 4 de Harraldson y cols. se asociaron a un incremento en el riesgo de CBD, mientras que la papila tipo 2 se asoció a un mayor riesgo de complicaciones; el uso de esta clasificación mostró una concordancia moderada entre endoscopistas expertos. Esta clasificación puede resultar de utilidad para predecir desenlaces adversos en pacientes sometidos a CPRE.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Difficult biliary cannulation (CBD) occurs in approximately 20% of endoscopic retrograde cholangiopancreatography (ERCP), and is associated with the development of complications, specifically post-ERCP pancreatitis. The morphology of the papilla of Vater could be associated to CBD; however, few endoscopic classifications are available, and none has been correlated with clinical outcomes.  Objective: To validate an endoscopic classification of the papilla of Vater and to analyze the association of papilla type with the risk of CBD and complications.  Material and methods: Retrospective, prolective, analytical and transversal study. Consecutive patients older than 18 years who underwent ERCP with a native papilla were included. To validate the endoscopic scale proposed by Harraldson et al., endoscopic images were distributed among 6 endoscopists to calculate interobserver variability using Cohen&#8217;s kappa coefficient. The gold standard was considered the consensus of two expert endoscopists; in case of disagreement, a third endoscopist gave guideline to the final result. The type of papilla was correlated with the rate of CBD and complications (post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation) using a logistic regression model.  Results: 100 patients were included (mean age 47 ± 19.1 years, 75% women). The main indication was high risk of choledocholithiasis. A kappa index of 0.634 (95% CI: 0.512-0.757) was obtained for expert endoscopists, 0.565 (95% CI: 0.439-0.692) for non-experts and 0.208 (95% CI: 0.048-0.367) for endoscopy fellows. The patients were divided according to the type of papilla in types 1 to 4. The percentage of CBD was lower for the papilla type 1, so it was chosen as a risk comparator. The papilla type 2 (OR 4.4 (95% CI 1.48-13.31, p = 0.008) and the papilla type 4 (OR 4.2 IC 95% 1.30 - 14.03, p = 0.016) were associated with an increased risk of CBD. Papilla type 2 (OR 3.18 IC 95% 1.08 - 9.34, p = 0.035) was associated with an increased risk of complications.  Conclusion: The type 2 and 4 papila of Harraldson et al classification were associated with an increased risk of CBD, while the papilla type 2 was associated with an increased risk of complications; the use of this classification showed a moderate concordance between expert endoscopists. This classification can be useful to predict adverse outcomes in patients undergoing ERCP.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[CPRE]]></kwd>
<kwd lng="es"><![CDATA[Canulación biliar difícil]]></kwd>
<kwd lng="es"><![CDATA[Papila de Váter]]></kwd>
<kwd lng="es"><![CDATA[Clasificación]]></kwd>
<kwd lng="en"><![CDATA[ERCP]]></kwd>
<kwd lng="en"><![CDATA[Difficult biliary cannulation]]></kwd>
<kwd lng="en"><![CDATA[Papilla of Vater]]></kwd>
<kwd lng="en"><![CDATA[Classification]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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